Physical Therapy Maneuver Disables Patient

Case Summary

A middle-aged woman with a past medical history of back surgeries underwent a lumbar discectomy and spinal fusion. Her orthopedist then prescribed her in-home physical therapy. The physical therapist instructed the patient to perform a modified push-up against the resistance of the physical therapist pushing down on her back. The exercise stopped when the patient heard a pop. Afterward, she experienced difficulty walking and subsequently contacted her surgeon, who felt that the physical therapist had done something inappropriate. Upon examination, the patient was found to have suffered a traumatic pelvic fracture. As such, the patient required numerous surgeries, including the placement of stabilization hardware. Currently, she is functionally bedridden due to pain and weakness caused by the injury.

Case Theory

Physical therapists are negligent when they fail to exercise the level of care that a reasonably prudent physical therapist would perform under similar circumstances. The most common forms of negligence committed by physical therapists include leaving patients unsupervised on equipment, therapy deemed inappropriate, aggressive maneuvers, ignoring patient’s complaints of pain, using broken equipment, failing to supervise, over-extending limbs, and failing to take the patient’s physical condition into account prior to administering treatments. When physical therapists deviate from accepted standards, they can easily cause injuries. Physical therapists who perform inappropriate care can result in patients suffering severe injuries including lower back injuries, spinal cord injuries, fractures, strains, sprains, and stroke.

These injuries can be even more dangerous as patients age due to a weaker skeletal structure and other medical conditions. Improperly performed or inappropriate techniques are the most common issues for a malpractice claim. In spinal fusions, heel slides, wall squats, and straight leg raises are commonly utilized exercises. They are also some of the most effective rehabilitative exercises to incorporate into a spinal surgery recovery regime.

Improper management and exercises that stress the skeletal area above and below the fusion can subject the patient to further injury. In this case, an inappropriate manual physical therapy maneuver breached the standard of care and led to damages and disability.

Expert Witness Specialities

Physical Therapy

An expert in physical therapy can review records and determine the appropriateness of the therapist’s maneuvers and standard of care regarding the patient’s past medical history.

Questions for Expert Witnesses

• What precautions do physical therapists take for patients with previous back surgeries to avoid similar complications while performing this maneuver?
• Under what circumstances should physical therapists perform resistance maneuvers post-discectomy?
• Did this physical therapist deviate from established therapy standards?

Expert Witness Involvement

Here is what the expert in physical therapy in this case had to say:

Expert Witness Response E-271241

I have over 30 years of practice experience with a significant number of patients matching the case outlined. I have encountered many such cases both in outpatient care, sub-acute rehab, and a couple myself in home care as a clinician. Low back pain is my specialty, and I teach this subject area in physical therapy at the university level. A person as described will have a weakened musculoskeletal system and rehab proceeds fairly slowly, though gentle resistance against a movement is not unusual and should not be a concern for regular bone fractures. I wonder if the person had an underlying condition of osteoporosis making the pelvis brittle since normal manual resistance should not cause a fracture unless the bones are unusually fragile. This, of course, depends on how the pressure was applied and exactly where. A traumatic fracture will normally only occur under significant pressure or if bones are weak.